POCUS using the neo-ECHOTIP protocol plus the retract,advance,and position (RAP) technique to improve lower extremity catheter positioning in neonates

Abstract

Background

International guidelines recommend point-of-care ultrasonography (POCUS) in neonatology for diagnostic, therapeutic, and procedural purposes. However, there are few standard protocols for using POCUS to confirm lower extremity catheter tip positioning.

Methods

In this prospective study, subcutaneously tunneled femorally inserted central catheters (ST-FICCs) were placed in eligible neonates according to physician orders. In line with the Neo-ECHOTIP (NE) protocol, a subcostal longitudinal view was used to identify the catheter, and saline flush test (SFT) was performed to confirm catheter tip placement below the right atrium. During the study, a novel “retract, advance, and position (RAP)” technique was added to the existing NE-SFT protocol to improve catheter positioning. Two-view radiographs of the chest and abdomen were obtained to verify catheter tip position for all subjects. The agreement rate with post-procedural radiographs and the total number of radiographs needed to achieve proper catheter positioning were assessed.

Results

The agreement rate of POCUS with radiographs for catheter terminal tip position was 75% (39/52) for the NE-SFT group compared to 100% (48/48) for the NE-SFT + RAP group (p < 0.001). Catheters in the NE-SFT group required repositioning (25%); no malpositioned catheters were observed in the NE-SFT + RAP group. Repositioning of the catheter in the NE-SFT group resulted in 22 repeat radiographs in the NE-SFT group; none were required in the NE-SFT + RAP group (p < 0.0001).

Conclusions

This single-center study demonstrated that applying the RAP technique to the Neo-ECHOTIP protocol improved the ease and accuracy of lower extremity catheter tip position localization in neonates, thus eliminating the use of radiography.